醫學筆記匯整 ED Notes

Hypersensitivity pneumonitis 過敏性肺炎
Farmer's lung 農夫肺
 

• 屬於 type 3 +4  hypersensititivy
  ( immune complex + T cell mediated )
  主要病灶位於肺泡
  肺泡間質肉芽腫 + 纖維化

• Restrictive lung disease  ( FVC 下降 )
  病理特徵為 fibrosis, honey combing

農夫肺是因為吸入了一些發霉稻草裡的熱性放線菌（Thermophilic  actinomycetes
引起肺部過敏反應，通常在吸入的 4–6 hours 小時之內會發生農夫肺的反應
症狀通常在幾天之內就會消失
若經常反覆性的接觸過敏，有可能會轉換成 亞急性 或 慢性 
進入 subacute, chronic 就不可逆了 !! 

1. Acute : fever, chills, malaise,
                 cough, chest tightness, dyspnea, rash, swelling and headache
    
2. Subacute :  productive cough, dyspnea,
                         fatigue, anorexia, weight loss, and pleurisy  
                        ( 症狀比 acute 和緩 )
    
3. Chronic :  insidious onset of cough,
                      progressive dyspnea, fatigue, and weight loss

• Organic or inorganic particles
  (microbes, animal or plant proteins, and certain chemicals)

要和 bronchial asthma 分清楚
asthma 是 type 1 過敏造成 Obstructive

 

* CASE : 
72 y/o male 
Cough, dyspnea on exertion for 3 month 
poor appetite
BW loss
yellowish sputum

首先 r/o TB + infection
AFB stain + culture 都一直 (-)
Curam 治療無效
Atypical 檢驗全部 (-)

再次 Hx taking 發現病程是從換了木地板後開始不舒服

CXR 明顯  R Volumn reduction
minor fissure 揚起
trachea 右偏
bilater upper lung consolidation, peripheral dominant
因為合併 Volumn reduction 
而且 lung marking crowding 
代表是 consolidation + fibrotic change 

CT 明顯 Honeycombing , Septal thickening